Cocaine use by pregnant women is a well documented phenomenon in the United States. Because of cocaine's effect on uterine blood flow and the central nervous system, cocaine-exposed children are predicted to have neurodevelopmental and behavioral abnormalities, and poor school performance. Our project, initiated in 1989, will continue prospective, blinded evaluations of cocaine-exposed and control children of similar low socioeconomic status for evidence of such long-term effects. The cohort, 101 cocaine-exposed and 118 controls, enrolled at birth (NIDA- R01 -DAO4965), now range in age from 2-5 years. To date these children have had >1000 visits, with an overall subject retention of 84%; they will be followed for an additional 5 years. The groups, previously similar in development, now show divergence with the cocaine-exposed children scoring lower than controls on the Battelle Developmental Inventory (BDI) and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). In the current proposal children will continue to be evaluated by psychologists, and through assessments of school achievement and adjustment. Mental organization (Goodman Lock Box), development (BDI), and intelligence (WISC-III) will be measured. School achievement and performance will be obtained from school records. Child behavior will be evaluated by teacher, parent, and psychologist report using standardized instruments. A neurologic examination will be performed when subjects reach age 5 years. Postnatal influences on the child will be evaluated using the Parent/Caregiver Involvement Scale, the Home Observation for Measurement of the Environment, the Inventory of Social Support, and assessments for lead toxicity. Continued addiction in the mother will be evaluated using the Addiction Severity Index and urine screening. Multivariable statistical analyses will be used to determine whether cocaine used in pregnancy poses an independent risk factor for adverse outcome. The study so far suggests that either prenatal or postnatal factors, or a combination of the two, are affecting performance of cocaine-exposed children on standardized tests. This proposal will: (1) delineate those factors that are the most important determinants of outcome; and (2) define specific areas of dysfunction so that appropriate interventions may be implemented.